Prescription only: the claims, the facts

Sep. 30, 2012

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As debate over a prescription-only requirement for pseudoephedrine begins in Springfield, experts, advertisements and strong opinions will influence the conversation. Several claims have been constant in the debate in communities across the country. The News-Leader explored some of those claims.

Claim: A prescription-only requirement would make treating a runny nose or sinus headache more inconvenient and expensive.

Even advocates acknowledge a prescription requirement for pseudoephedrine would burden, to some extent, the law-abiding community.

If council passes an ordinance similar to other Missouri municipal bans, patients would need to have a doctor prescribe any amount of the drug.

Matthew Stinson, a family doctor at Jordan Valley’s Community Health Center, said if a prescription-only ordinance passed, some doctors might call in prescriptions for pseudoephedrine while other might require a doctor’s visit.

“It just depends on the provider,” he said.

Stinson estimated a doctor’s appointment in Springfield generally costs between $75 and $150 without insurance.

But other over-the-counter decongestants are comparable to pseudoephedrine, though might not be as effective. He said phenylephrine is a good alternative.

Stinson believes a small subset of people, those who use pseudoephedrine daily, would be most affected.

“They will need to have a conversation with their doctors.”

Ken Powell, a doctor with CoxHealth, believes whatever inconvenience might be created, the benefits of a prescription requirement make the trade-off worthwhile.

Powell said Cox sees a “tremendous” number of people with meth-related health issues.

“This is just a devastating problem that we are not making any headway on,” he said.

Family Pharmacy owner Lynn Morris believes pseudoephedrine could become more expensive if a prescription is required. He said reducing the legal limit a person can buy is a better action for the city to take.

The degree of inconvenience may depend largely on the specifics of a Springfield measure.

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Those specifics have not yet been defined, but some — including Councilman Jeff Seifried, who proposed the ordinance — believe a ban can be effective without banning gel or liquid forms of pseudoephedrine.

New drugs, touted as being meth-resistant pseudoephedrine, are expected to hit the market in November and might also be exempt.

Claim: Meth cooks will find a way to make methamphetamine without pseudoephedrine.

Springfield officers have documented how meth has been made locally since the ’90s, when the drug first started its surge. Back then, a type of ammonia fertilizer — a poisonous gas — was often used in the production.

More recently, lithium, a chemical stripped from batteries used in cell phones and laptops, is more commonly used. Red phosphorus from road flares and starter fluid can also be common ingredients.

Several household items can be substituted and exchanged to achieve the desired chemical reaction but one ingredient remains constant.

“You’ve got to have pseudoephedrine. That’s where it all starts,” said Sgt. Bryan DiSylvester, supervisor of the department’s narcotics unit.

In fact, the process of cooking meth, DiSylvester explained, is meant to slightly alter pseudoephedrine, at a molecular level, to create methamphetamine.

“You’ve got to have the core substance,” he said.

DiSylvester acknowledged Mexican drug organizations have been making meth without pseudoephedrine by using a chemical known as P2P.

“But you can’t buy P2P from Walgreens,” he added.

In the U.S., P2P is a highly regulated controlled substance, he said. Buying it — and making meth from it — is much more difficult and labor intensive.

Claim: The current system is working.

The current system links Missouri’s 1,300 pharmacies and tracks pseudoephedrine purchases using the buyer’s driver’s license number.

If a person exceeds a 9-gram limit in 30 days, that person is flagged and the sale is denied. An individual customer is also barred from buying more than 3.6 grams — 120 standard tablets — of any pseudoephedrine product in one day.

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The bills for the system and its maintenance are being picked up by the pharmaceutical industry. The cost to taxpayers is zero.

When the system went online in September 2010, lawmakers and industry officials touted the program as a protection for Missouri consumers and a tool to fight meth production.

Records of pseudoephedrine purchases in Greene County show some evidence that the current tracking system is blocking some sales of the drug, limiting the amount sold to any one individual.

During a recent 30-day period, Greene County pharmacies sold 5,262 boxes of pseudoephedrine. During the same period, 649 boxes were denied.

That suggests the sale of one out of every 10 boxes of the popular cold and allergy medication is getting blocked by vigilant pharmacists informed by the statewide database.

The data was provided to the News-Leader by Springfield police.

Opponents of a prescription-only ordinance say these numbers prove the tracking system is thwarting meth makers.

Chief Paul Williams acknowledged the system is having a “limited effect.” But, he added, “It’s not the panacea we were told it was going to be.”

DiSylvester says the database has not resulted in a single bust. In fact, he believes the system does nothing to prevent a criminal enterprise known as “smurfing,” or using various people to buy legal amounts of pseudoephedrine and pooling the spoils to make meth.

Claim: A prescription-only requirement would not only reduce labs but it would reduce meth use, overall crime rates and other meth-related problems.

Advocates for a prescription requirement often point to statistics from Oregon and Mississippi — both passed statewide bans.

Both states saw a significant drop.

Rob Bovett, district attorney in Lincoln County, Oregon, is a strong defender of his state’s prescription-only law, stressing its impact on reducing dangerous meth labs. But, he warned that limiting domestic production of meth doesn’t necessarily lead to a reduction of meth use.

Although meth use has declined in Oregon, Bovett attributes the drop more to 2008 restrictions on pseudoephedrine in Mexico, which shrank supply and potency across the U.S.

He believes the Oregon law deserves some of the credit for reducing crime.

“Addicts steal to support their addiction,” he said.

“When you get a better handle on it, you naturally see a reduction in crime. It’s really not rocket science.”